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Hospitalisation for more than 3 days after thrombolysis for uncomplicated myocardial infarction was not cost effective

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 QUESTION: For patients who have had a low risk myocardial infarction (MI), is early discharge on day 3 instead of day 4 after thrombolysis safe and cost effective?


Decision analytic model using data from a randomised controlled trial (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO-1]).


{1081 hospitals in 15 countries}*.


38 911 of 41 021 enrolled patients who presented with a confirmed MI 20 minutes to 6 hours after symptom onset and who had an uncomplicated course (absence of death, reinfarction, congestive heart failure, recurrent ischaemia, stroke, shock, emergency angiography or angioplasty, bypass surgery, intra-aortic balloon pumping, cardioversion, or defibrillation). Exclusion criteria were angiographic 3 vessel or left main coronary artery disease or elective bypass surgery >3 days after thrombolysis.


Discharge at day 3 compared …

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  • Sources of funding: Bayer; CIBA-Corning; Genentech; ICI Pharmaceuticals; Sanofi Pharmaceuticals.

  • For correspondence: Dr L K Newby, Duke Clinical Research Institute, PO Box 17969, Durham NC 27715-7969, USA. Fax +1 919 668 7059.

  • * The GUSTO Investigators. N Engl J Med 1993;329: 673–82.